Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment in CKD

Christian D Peters; Kevin K W Olesen; Esben Laugesen; Michael Mæng; Hans Erik Bøtker; Per L Poulsen; Niels Henrik Buus

doi:10.1016/j.ekir.2023.11.001

Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment in CKD

Kidney Int Rep. 2023 Nov 7;9(2):296-311. doi: 10.1016/j.ekir.2023.11.001. eCollection 2024 Feb.

Authors

Christian D Peters^{1

2}, Kevin K W Olesen³, Esben Laugesen^{4

5}, Michael Mæng^{2

3}, Hans Erik Bøtker², Per L Poulsen^{2

5

6}, Niels Henrik Buus^{1

2}

Affiliations

¹ Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
² Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
³ Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
⁴ Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.
⁵ Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, Aarhus, Denmark.
⁶ Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.

Abstract

Introduction: Central aortic blood pressure (BP) could be a better risk predictor than brachial BP. This study examined whether invasively measured aortic systolic BP improved outcome prediction beyond risk prediction by conventional cuff-based office systolic BP in patients with and without chronic kidney disease (CKD).

Methods: In a prospective, longitudinal cohort study, aortic and office systolic BPs were registered in patients undergoing elective coronary angiography (CAG). CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m². Multivariable Cox models were used to determine the association with incident myocardial infarction (MI), stroke, and death.

Results: Aortic and office systolic BPs were available in 39,866 patients (mean age: 64 years; 58% males; 64% with hypertension) out of which 6605 (17%) had CKD. During a median follow-up of 7.2 years (interquartile range: 4.6-10.1 years), 1367 strokes (CKD: 353), 1858 MIs (CKD: 446), and 7551 deaths (CKD: 2515) occurred. CKD increased the risk of stroke, MI, and death significantly. Office and aortic systolic BP were both associated with stroke in non-CKD patients (adjusted hazard ratios with 95% confidence interval per 10 mm Hg: 1.08 [1.05-1.12] and 1.06 [1.03-1.09], respectively) and with MI in patients with CKD (adjusted hazard ratios: 1.08 [1.03-1.13] and 1.08 [1.04-1.12], respectively). There was no significant difference between prediction of outcome with office or aortic systolic BP when adjusted models were compared with C-statistics.

Conclusion: Regardless of CKD status, invasively measured central aortic systolic BP does not improve the ability to predict outcome compared with brachial office BP measurement.

Keywords: cardiovascular disease; chronic kidney disease; cuff-measured brachial blood pressure; invasive aortic blood pressure; mortality; systolic blood pressure.